Community Health Program
OVERVIEW
The University of Rochester Medical Center (URMC) serves as the dominant provider of primary care for the Rochester, New York community, as well as the regional referral center for Western and Central New York State. It includes the School of Medicine and Dentistry, the School of Nursing, the Eastman Dental Center, Strong Memorial Hospital, Golisano Children's Hospital at Strong, and Highland Hospital, as well as adult nursing facilities and a visiting nurse service. As a relatively small private academic health center, we are proud to be in the top 25% of medical schools in NIH research funding. Moreover, highly pertinent to community service is the #2 ranking of our Department of Community and Preventive Medicine according to U.S. News & World Report.
Community service and outreach have long been a tradition at URMC. In fact, when the Medical Center's major benefactor, George Eastman, was initially approached for funding, he agreed to provide the seed money, but with a caveat: to use the skills and talents within URMC to create the world's healthiest community in Rochester. Over the years, we have endeavored to fulfill this philosophy, and at the mark of the new millennium, Medical Center leadership recommitted to Eastman's vision with a renewed passion, integrating the Medical Center's research, education and patient care efforts with community-identified needs. Today, our efforts go well beyond the traditional service role of academic medicine, as we pledge to make Rochester one of America's healthiest communities. We have established the following administrative organization to guide our community health initiatives:
- The Senior Vice President for Health Affairs and the Dean of the School of Medicine provide overall leadership, ensuring integration of community outreach efforts across all Medical Center departments, school and centers. The Center for Primary Care and the Department of Community and Preventive Medicine (DCPM) are the academic homes for our efforts, and the chairs and senior faculty within these units facilitate community-based research, outreach and education endeavors that are grounded in the science of prevention, risk reduction and patient care services. Additionally, the Office of Local Government and Community Relations provides administrative support for community outreach efforts as necessary. (Attachment 1)
- A National Advisory Board comprised of prominent community health experts meets regularly by conference call to provide URMC with information and expertise on national model programs and best practices in community health. (Attachment 2)
- For strategic guidance, URMC looks to one of its most renowned alumni, 16th Surgeon General of the United States David Satcher, M.D., Ph.D., who serves as our Senior Advisor for Community Health. With his guidance and expertise, URMC has continued to find ways to listen to the needs of the community and respond accordingly. Dr. Satcher provides periodic consultation on the overall progress of the community health mission, and makes at least two site visits annually.
Our Community Service Approach
"We are proud (of) the #2 ranking of our Department of Community and Preventive Medicine according to U.S. News & World Report."
At the heart of our approach is an understanding that a healthy community means more than just the absence of disease. Changing the emphasis of health care from treatment to prevention, decreasing unhealthy lifestyle behaviors, and researching and employing new advances in early detection and treatment are our core strategies to positively impact the health of our community. We seek to apply the expertise of our faculty and staff to areas identified by three key community consortiums, two of which represent the interests of Rochester's largest minority populations and their unique needs. They include HealthACTION, a coalition led by the Monroe County Health Department, which assesses and then attempts to favorably impact the health status of county residents; the African American Health Status Task Force, which addresses the health status of African Americans in the Rochester region; and the Hispanic Health Coalition, a 20-member community task force representing the interests and needs of the Hispanic population. The issues identified by these three coalitions are remarkably aligned with the Healthy People 2010 Leading Indicators, and address common health disparities that exist in these populations.
One Neighborhood at a Time
An example of interaction between Medical Center faculty and community groups is the unique relationship the Medical Center has established with the Jay/Orchard street neighborhood in the city of Rochester. An intensive effort links URMC resources to community-identified priorities to improve the health status of this poverty stricken area. By dedicating multiple resources in a focused and coordinated manner, we are creating practical solutions that can then be replicated in vulnerable neighborhoods throughout Rochester and the nation.
The Jay/Orchard street area is categorized as a federal census track "Red Zone" with the highest rates of poverty, unemployment, public assistance, teenage births, crime, morbidity and mortality. Recognized as one of the poorest communities in the nation, the majority of households are single-parent families headed by women, and are disproportionately affected by poor health outcomes, barriers to access, lack of health education opportunities or lack of utilization.
Our work in the Jay/Orchard street neighborhood is focused in three areas: building the capacity of the grassroots neighborhood organization; programs aimed at improving the health of residents; and programs designed to build hope and revitalize the neighborhood. No less than eight Medical Center departments and dozens of faculty and staff actively deploy various community outreach efforts in this neighborhood. DCPM and the Local Government and Community Relations office coordinate all faculty and staff initiatives in this neighborhood to avoid duplication and ensure best use of resources in our focus areas.
Building the Capacity of the Grassroots Neighborhood Organization: An important component of our work is our partnership with JOSANA, the Jay/Orchard Street Area Neighborhood Association, to help it foster dramatic and sustained change in their neighborhood. Our faculty have provided strategic planning assistance to JOSANA to help prioritize issues that can have the greatest impact on the health of this neighborhood, and continue to work side-by-side to plan initiatives, write grants and measure the success of programs. On-going administrative support is provided to JOSANA, including office space in our portion of the area's dental/health clinic, and the donation of more than 20 laptops, complete with Internet access, for JOSANA to use as a way to quickly and efficiently communicate with and between neighborhood street captains. Additionally, the Medical Center is guiding JOSANA through the process of applying for non-profit status, a necessary step to help attract funding to support its work.
Improving the Health of the Residents: In any given week, our medical students are actively involved in either running health improvement programs for neighborhood children and their families, or actively providing health services under the supervision of a physician at the neighborhood health clinic (see CHIC on page 5). In addition, one major initiative led by the Medical Center is well on its way to eradicating a major health hazard in the neighborhood and across the country: lead poisoning.
Lead-poisoned children are seven times more likely to drop out of school and six times more likely to have a learning disability. At its extreme, it can result in permanent, irreversible brain damage, and is a contributing factor to chronic disease. In the Jay/Orchard street area, the situation is dire. A study conducted by the area's grammar school found that 41% of incoming students had blood levels above the CDC recommended "safe level." URMC's Environmental Health Sciences Center worked with professionals in the neighborhood community health center and JOSANA to create Get the Lead Out of Orchard Street Community Houses and Kids, or GLO, an innovative, community-based prevention program designed to protect children before they are poisoned.
Through GLO, doctors in the neighborhood's health clinic identify children at their well-child checkups who live in high-risk homes. GLO then arranges for an EPA certified risk assessment of the lead hazards in the home, and specially trained medical students act as case workers, visiting the families to present and interpret the findings of the assessment, and educate the family on how to minimize lead poisoning risks. Since 85% of the homes in the Jay/Orchard street area are rental properties, GLO also interacts directly with property owners to encourage them to make repairs and link them with potential funding sources.
In addition to direct family and property owner interaction, faculty and medical students actively educate the community about the dangers of lead poisoning through regular attendance at various community meetings, participation in health fairs and other outreach activities. GLO also provides scientific data and poignant case histories to key government leaders to clearly illustrate how a simple change to legislation has the potential to virtually eliminate lead poisoning rates in the city.
As the only program of its kind in the country that is based on intervention through primary health care systems and that provides a full risk assessment of the home, GLO has been a resounding success. To date, more than 60 homes have been inspected, and the GLO team has made approximately 20 presentations to key community groups, and participated in a half-dozen community health fairs. However the real success of GLO is how it has parlayed its learning experiences into a powerful catalyst for public policy change and community endorsement of supporting the elimination of lead poisoning in Rochester by 2010. GLO has helped to create and change lead-related city ordinances, and has spurred new county legislation. It has more than doubled its funding in one year, with grants pending to expand the GLO model to two additional communities in Rochester.
Building Hope and Reinvigorating the Neighborhood: In 2001, the Jay/Orchard street neighborhood was deeply affected by the tragic death of a 10-year-old who was hit by a stray bullet during a drug dispute. The senseless death of one so innocent and young, on the heels of multiple homicides in this same area, served as a wake-up call and spurred the neighborhood into action. At the advice of Dr. David Satcher to engage the community in improving the quality of life, the Medical Center identified the importance of including children in the revitalization to ensure they had an active role in helping to reshape the neighborhood.
The result was Children's Vision and Voices, which gave sixth graders a venue to speak out and write about issues that affect the quality of their lives and their neighborhood. Launched in September 2003 with a town meeting facilitated by Dr. Satcher, the children discussed the signs of health and illness, both on personal and community levels. The students then were given disposable cameras and asked to photograph issues in their community that they felt negatively impacted the health of residents. Each student selected one photo and wrote a short essay, and these were compiled into a 64-page heart-wrenching booklet, with page after page depicting abandoned houses, litter, graffiti, drugs, homeless people and tombstone memorials, as seen everyday by these children.
Perhaps most poignant was the wisdom the children displayed in planning the final phase of the program. The students were asked to brainstorm on a project to address one of the issues depicted in the booklet. Permanent monuments, such as a Peace Park or new basketball courts, were discussed, but the children felt that these would eventually be vandalized because of a pervasive lack of respect for property among residents. So, instead, the students are organizing a "Take Pride in Our Neighborhood Day." More than just a one-time neighborhood cleaning day, the students are working with various organizations to help change the consciousness of the neighborhood so that residents will begin to take pride in caring for their community.
While far from a sophisticated, expensive research study, this compilation has resulted in engaging community leaders in understanding the plight of this local community in a way that no published research study could. The project has received local and national attention, helping to raise awareness and much-needed funds for the poorest of neighborhoods. In addition, many inquiries have been received by organizations hoping to replicate this program in their community.
Select Programs and Initiatives: In addition to the work that takes place in the Jay/Orchard street area, hundreds of faculty and staff from at least 15 URMC departments and/or centers implement more than 75 community service programs and interventions annually. Some are pilot projects, others are long-standing commitments to community organizations, and still others are permanent programs established after their results earned them permanent funding sources. Most link back to the issues identified by HealthACTION, the African American Health Status Task Force, and the Hispanic Health Coalition, and all demonstrate the Medical Center's longstanding commitment to address community and social needs not being met by the traditional health system. A listing of some of our most successful programs follows, categorized into two main categories: Community-based services to study and improve access to care, and integrating community health into medical education.
